Note: American pawpaw (Asimina triloba) is not a papaya and should not be confused with Carica papaya or Annona muricata (graviola) although the species have similar common names and may be called "pawpaw."

American pawpaw (Asimina triloba) is a fruiting tree native to North America. However, plantings of the tree can be found in Asia, Australia, and Europe. Pawpaw extract is made from the twigs of the tree.

In the 1980s and 1990s, researchers at Purdue University isolated compounds from pawpaw bark extracts. Many of these compounds were found to have cytotoxic effects on cancer cell lines. Currently, there is a lack of available scientific evidence supporting the safety or effectiveness of pawpaw for any condition.

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

GRADE *

Pawpaw extract may have some anticancer activity, but additional study is needed to make a firm recommendation.

C

Pawpaw extract in combination with thymol and tea tree oil in a shampoo formulation may be effective for the eradication of lice. Better-quality study using pawpaw alone is needed before a firm recommendation can be made.

C

* Key to grades

A: Strong scientific evidence for this useB: Good scientific evidence for this useC: Unclear scientific evidence for this useD: Fair scientific evidence for this use (it may not work)F: Strong scientific evidence against this use (it likley does not work)

Tradition / Theory
The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

Dosing from scientific studies has not been proven safe or effective. For cancer, 12.5-50 milligrams of extract has been taken by mouth four times a day with food for periods of up to 18 months. For lice, 40 milliliters of Paw Paw Lice Remover Shampoo® (0.5% pawpaw extract, 1% thymol, and 0.5% tea tree oil) applied three times to dry hair, once every 8 days for up to 24 days, has been used.

Children (younger than 18 years)

Dosing from scientific trials has not been proven safe or effective. For lice, 40 milliliters of Paw Paw Lice Remover Shampoo® (0.5% pawpaw extract, 1% thymol, and 0.5% tea tree oil) applied three times to dry hair, once every 8 days for up to 24 days, has been used.

Safety
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

Avoid in individuals with a known allergy or hypersensitivity to Asimina triloba, or any other members of the Annonaceae plant family (including other species of Asimina, and those in the genera Annona, Deeringothamnus, Disepalum, Goniothalanus, Rollinia, Uvaria, and Xylopia).

Side Effects and Warnings

There is a lack of safety information about pawpaw extracts. The constituents in pawpaw extract are cytotoxic. Taking pawpaw extract by mouth is not recommended without the supervision of a qualified healthcare professional, including a pharmacist.

Patients with gastrointestinal problems or a history of skin reactions should use pawpaw cautiously, because both nausea and vomiting have been reported after taking pawpaw by mouth.

Patients with known allergy or hypersensitivity to Asimina triloba, or any other members of the Annonaceae plant family should avoid pawpaw due to the possibility of developing urticaria ("hives"), reddening of the skin or itching.

Pregnancy and Breastfeeding

Use during pregnancy or breastfeeding is not recommended due to the cytotoxic effects of pawpaw extract.

Pawpaw extracts may interact with antioxidant medications. Caution is advised.

Interactions with Herbs and Dietary Supplements

The combined use of 7-keto and pawpaw extract may lessen the effect of 7-keto and combined use of these agents may be ineffective. Patients taking herbs and supplements should consult with a qualified healthcare professional, including a pharmacist, before combining therapies.

Pawpaw may interact with coenzyme Q10. It may also interact with antioxidant herbs and supplements. Caution is advised.

McCage CM, Ward SM, Paling CA, et al. Development of a paw paw herbal shampoo for the removal of head lice. Phytomedicine 2002;9(8):743-748.

McLaughlin, JL. A novel mechanism for the control of clinical cancer: inhibition of the production of adenosine triphosphate (ATP) with a standardized extract of paw paw (, Annonaceae) (Unpublished). 2001.

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.